NPI | 1063229425 |
---|---|
Entity Type | Organization |
Authorized Contact | KELSEY ROPER Office Administrator 844-365-2202 |
Organization Subpart ? | No |
Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care |
Enumeration Date | 2024-12-18 |
Last Update Date | 2024-12-18 |